Unprecedented Trauma Resulting From Pandemic Creating Unique Challenges for Providers

Between its scope and longevity, the COVID-19 pandemic has taken the link between trauma and addiction to uncharted waters.

While data has long shown a potentiating increase in trauma and substance use disorder (SUD) patterns for up to 3 years after catastrophic events, the pandemic has created an unprecedented challenge for behavioral healthcare professionals.

On Saturday at the East Coast Symposium on Addictive Disorders, Kenneth L. Roberts, MPS, LPCC, LADC, chief clinical officer for the NUWAY not-for-profit program in Minneapolis, discussed the concept of pandemic trauma and stress experience (PTSE), including what sets it apart from post-traumatic stress disorder (PTSD). Ahead of his presentation, Roberts spoke with Addiction Professional about PTSE and evidence-based modalities for treatment.

Editor’s note: This interview has been edited for length and clarity.

Addiction Professional: How would you define pandemic trauma and stress experience (PTSE)?

Kenneth L. Roberts: PTSE is a construct developed by the American Psychoanalytic Association (APsaA) to capture the scope of internal and interpersonal psychological consequences that have built up during the COVID-19 pandemic impacting individuals, families, and communities. PTSE highlights the myriad range of individualized reactions at these levels, including fear, anxiety, worry, anger, and isolation. The APsaA contends that all of us have experienced some level of PTSE. Many of the reactions match PTSD symptomology. The ApsaA advisory committee hoped that developing this constellation would offer providers context to differentiate the 2 and prevent potential misdiagnosis.

AP: How can clinicians differentiate between PTSE and post-traumatic stress disorder (PTSD)?

KR: This is an excellent question that gets at that potential for misdiagnosis and highlights the need for clinical fidelity in carefully assessing the DSM-V criteria for PTSD. Screening tools offer a good starting point, but a full diagnostic assessment is required to reach a formal diagnosis. Clinical PTSD requires symptoms in 4 categories: intrusion, avoidance, negative changes in thought/mood, and changes in arousal/reactivity that impact functionality for over 1 month. Awareness of how pandemic life has impacted all of us is a helpful reminder that not all trauma leads to PTSD, but that the conditions we have endured in the last several years are likely an amplifying factor for individuals already struggling with SUD and mental health concerns and certainly represent heightened risk for those with existing PTSD.

AP: Can you share some evidence-based treatment modalities for treating trauma, as well as best practices for establishing a trauma-informed clinical practice setting?

KR: Thankfully, I think we are doing a much better job as a field in recognizing the impact of trauma in the populations we serve. Gabor Mate, MD, posits that all SUD has its roots in some form of trauma, and I find that to be a useful conceptualization. We have greater recognition of how the traumas of adverse childhood experiences (ACE) impact our youth and play out for them as adults. That dynamic has been greatly exacerbated during the pandemic and has generational implications for our field. 

The term “trauma-informed care” is a term that gets thrown around a lot—it’s important to remember that TIC should really be focused on safety for everyone (clients and staff) at an agency level and requires both leadership support and ongoing training to sustain that culture. The 5 guiding principles for trauma-informed care are the following: safety, choice, collaboration, trust, and empowerment.

Clinically, we are seeing lots of exciting emerging modalities for trauma treatment that appear to demonstrate positive outcomes but will require further study validation. Psychedelic therapies have received a good deal of attention recently and appear to be on the verge of breaking into the mainstream. The core evidence-based modalities for treating PTSD specifically all have roots in cognitive behavioral therapy. Prolonged exposure (PE) and cognitive processing therapy (CPT) are effective manualized treatments, while eye movement desensitization and reprocessing (EMDR) and accelerated resolution therapy (ART) utilize eye movements for bi-lateral stimulation. All of these require a clinical mental health credential and training/certification to practice. Yoga, art, music, and pet therapies along with a number of curriculums such as Seeking Safety and Beyond Trauma, all provide a robust range of individualized options and tools to help meet individuals where they are in terms of need and readiness.

AP: Is there anything you’d like to add that we have not touched on?

KR: There is a great video called “The Social Experiment” that I would recommend as a resource for education. It captures the isolation experienced by individuals experiencing PTSD. Trauma and PTSD are rooted in shame, stigma, and isolation. I think we can all relate more to isolation in the wake of the pandemic. The time we are living in right now offers us a greater societal opportunity to bring trauma out of the shadows and ensure everyone dealing with trauma gets the help they need. That would signal a better world for all of us!

Reference

Roberts KL. Understanding and addressing post-pandemic trauma impact. Presented at: East Coast Symposium on Addictive Disorders. Aug. 19-21, 2022. Baltimore, Maryland.